Association between high dose catecholamine support and liver dysfunction following cardiac surgery

Abstract

Background Cardiac surgery using cardiopulmonary bypass is a well‐established procedure. However, up to 20% to 30% of patients require high dose vasopressor or inotropic support following surgery, enhancing the risk of organ dysfunction and impacting mortality. Nonalcoholic fatty liver disease (NAFLD) is a frequent finding in these patients and may be involved in the pathophysiology of vasoplegia and cardiac failure. Methods Retrospective analysis of 463 patients undergoing elective cardiac surgery in 2014 at our institution. NAFLD was defined using the NAFLD fibrosis score and the vasoactive‐inotropy score was used to determine postoperative vasopressor and inotropic dependency. Results Patients with NAFLD more often presented with high vasopressor or inotropic support compared to patients without NAFLD, resulting in significant differences after 6 hours (n = 20 [27.0%] of 74 patients), 12 hours (n = 20 [27.0%] of 74 patients), and on the first postoperative day (n = 12 [16.4%] of 73 patients) of intensive care unit (ICU) treatment. Multivariate analysis revealed time of catecholamine application (P = .001), preoperative left ventricular ejection fraction (P = .001), type of surgery (P = .001), model of endstage liver disease on hospital admission (P = .002), pre‐existing pulmonary hypertension (P = .004) and NAFLD‐time interaction (P = .05) as independent predictors of high vasopressor and inotropic support. Patients with NAFLD had higher degrees of extrahepatic organ dysfunction, were more dependent on hemodialysis, spent more days in the ICU and within the hospital. Patients with NAFLD and high catecholamine support had the highest mortality rates among the study population. Conclusions NAFLD is a common finding in elective cardiac surgery patients. Anesthesiologists and intensivists should be sensitive for the specific risk profile of this population.

The Effects of Different Doses of Sufentanil on Intraoperative Cardiovascular Response and Postoperative Recovery in Patients Undergoing Cardiac Surgery: A Retrospective Cohort Study

“…26 The use of large amounts of vasoactive drugs may be associated with an increased risk of organ dysfunction and increased postoperative in-hospital mortality. 27,28 In this trial, the utilization rate of vasoactive drugs in the high-dose sufentanil group during surgery was lower than the cohorts in other studies, which was 54.5%. This may be related to the stable hemodynamics during the operation and the low incidence of malignant arrhythmia.…”

A Narrative Review on the Role of AMPK on De Novo Lipogenesis in Non-Alcoholic Fatty Liver Disease: Evidence from Human Studies

“…Our group has shown that NAFLD subjects undergoing major hepatic surgery frequently show impaired functional liver recovery [ 36 ]. In cardiac surgery, NAFLD is a predictor of high vasopressor support, of extrahepatic organ dysfunction, and of a longer intensive care and hospital stay [ 37 ].…”

The Role of Physical Activity in Nonalcoholic and Metabolic Dysfunction Associated Fatty Liver Disease

“…In the US, metabolic fatty liver disease is currently the second leading etiology of HCC-related liver transplantation and patients undergoing major surgery have more perioperative complications and longer hospital stay. After transplantation there is a significant risk of de novo T2D and NAFLD/MAFLD, and furthermore of premature death from cardiovascular complications and sepsis [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Together, MAFLD/NAFLD has to be considered a multisystem disease, as hepatic manifestation of the metabolic syndrome (MeSy)/T2D and can influence patient prognosis [ 39 , 41 , 42 ].…”